P-589: Stenting for atherosclerotic renal artery stenosis (RAS) in diabetes: are the benefits worth the risks to the kidney?

• Published in: American journal of hypertension Vol. 16; no. S1; p. 252A
• Main Authors: Jelinkova, Hana, Schirger, Alexander, Odlova, Zuzana, McKusick, Michael A, Stanson, Anthony W, Textor, Stephen C
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.05.2003
• Subjects: Diabetes; Renal artery stenosis; Stent
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/S0895-7061(03)00762-3

Whether the benefits of improved blood pressure control offset the risks of increased renal perfusion pressure after renal artery revascularization in diabetic patients with proteinuria is not known. We studied the clinical characteristics, BP, creatinine, and estimated daily urine protein excretion in 258 subjects undergoing stenting for atherosclerotic RAS between 1996-2001. 100 patients with DM were subdivided into Diet Rx (n=38), oral hypoglycemic agents (n=29), or insulin dependent (n=33). Pre-stent BP, sex, cholesterol, smoking, age, and medications did not differ between groups. BP fell and ACE/ARB therapy was used to a similar extent in all groups after stenting. Glycosylated hemoglobin and pre-stent Uprotein varied by diabetic status was highest in oral agent and insulin dependent DM (p<.01). Uprotein rose after stenting in diet Rx (287 vs 719 mg/d, p<.05), despite reduced arterial pressures. Uprotein and serum creatinine were unchanged in DM with oral or insulin Rx after stenting. These data indicate that stent placement in DM patients leads to improved BP control comparable to those without DM. Proteinuria rose during follow-up in early DM despite improved BP. More advanced DM with proteinuria was not adversely affected. Our results argue that stenting in patients with DM offers major improvement in CV risk without jeopardizing the kidney in insulin-dependent and oral hypoglycemic treated diabetes. (See Table) Non-DM Diet Rx Oral Agents Insulin HgbAlc (%) 6.0 ± .4 7.16 ± .3 8.1 ± .4# 8.5 ± .3# SBP (mm Hg) 169 ± 2 165 ± 5 167 ± 4 168 ± 5 DBP (mm Hg) 84 ± 1 80 ± 3 77 ± 2 80 ± 3 Creatinine (mg/dL) 1.64 ± .07 1.83 ± .16 1.69 ± .016 1.98 ± .15 Uprotein (mg/d) 481 ± 93 287 ± 79 899 ± 342# 1412 ± 455# Last follow-up after stenting: (489 ± 23 days) SBP (mm Hg) 146 ± 2* 146 ± 5* 147 ± 6* 148 ± 4* DBP (mm Hg) 74 ± 1* 71 ± 2* 70 ± 3* 75 ± 2* Uprotein (mg/d) 514 ± 116 719 ± 223* 359 ± 186 1405 ± 650# Creatinine (mg/dL) 1.71 ± 11 1.88 ± .21 2.04 ± .26 1.98 ± .19 #vs non-DM, *p < .01 vs pre-stent.